Manager, Actuary

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Manages monthly IBNR development and other liabilities valuations.
• Reconciles claims data with general ledger for identifying and explaining discrepancies.
• Automates and improves the valuation models and processes.
• Communicates reserving recommendations and P&L impacts to senior management.
• Leads key quantitative and qualitative analyses inclusive of cost and utilization tracking, rate build-up, MLR reporting, and member cohort analyses.
• Provides financial and medical economics data support for care and utilization management, new product launches, IPA arrangements, vendor contracting, budget planning and Medicare bid.
• Maintains and updates the risk adjustment models used for developing risk adjustment accruals, reconciling risk scores, identifying data reporting gaps and projecting risk scores for Medicare bid.
• Supports annual Medicare bid including data collection and cleansing, trend development, financial reconciliation and pharmacy related analyses.
• Serves as actuarial project lead for all regulatory entities - Centers for Medicare and Medicaid Services (CMS), National Association of Insurance Commissioners (NAIC), Department of Health (DOH), rate reviewers, auditors, etc.
• Oversees the collection and preparation of materials to be used as references in audit related activities.
• Liaises with internal departments to create strong lines of communication in all areas that impact actuarial functions.
• Performs all duties inherent in a managerial role.
• Ensures effective staff training, interviews candidates for employment, evaluates staff performance and conducts annual performance appraisal, and recommends hiring, promotions, salary actions, and terminations, as appropriate.

Licenses and Certifications:

• Associate of the Society of Actuaries (ASA) designation preferred

Education:

• Bachelor's Degree in Mathematics, Actuarial Science, Statistics, Biostatistics, or related discipline required

Work Experience:

• Minimum of six years of progressively responsible actuarial experience in a Health Plan/ Managed Care organization or similar environment at least some of which in a supervisory role, Medicare and Medicaid background preferred
• Expert knowledge of Actuarial Standards of Practice (ASoPs), Centers for Medicare and Medicaid Services (CMS), National Association of Insurance Commissioners (NAIC).
• Expert knowledge of core health actuarial processes including Pricing, Valuation, and Budgeting/Forecasting required
• Experience composing and facilitating presentations.
• Efficiency in manipulating and analyzing large and complex data sets from multiple sources using SAS or Python
• Proficient in MS Excel spreadsheets and Visual Basic
• Ability to communicate quantitative analyses and results in a clear, precise and actionable manner.